1073725990 NPI number — FRAMINGHAM CARDIOLOGY DIAGNOSTICS

Table of content: (NPI 1073725990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073725990 NPI number — FRAMINGHAM CARDIOLOGY DIAGNOSTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRAMINGHAM CARDIOLOGY DIAGNOSTICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073725990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 WORCESTER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702-5259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-620-2800
Provider Business Mailing Address Fax Number:
508-620-2808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 LINCOLN STREET
Provider Second Line Business Practice Location Address:
METROWEST MEDICAL CENTER
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-879-6026
Provider Business Practice Location Address Fax Number:
508-879-8958
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MELENCIO
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING AGENT
Authorized Official Telephone Number:
508-620-2800

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  NOT APPLICABLE , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9766146 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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